Aims: To examine trajectories of anxiety and depression (psychological distress) over the first year following the diagnosis of advanced breast cancer(ABC), and identify factors differentiating trajectory membership.
Methods: 229/246 (93%) Chinese women newly diagnosed with ABC (Stages 3-4) were recruited from 6 public clinical/surgical oncology units and completed an interview before their first course of chemotherapy, and follow-up interviews at 6 weeks, 12 weeks, 18 weeks, and 12 months subsequently. At baseline, participants were assessed for supportive care needs (SCNS-34), psychological distress (HADS), symptom distress (MSAS), optimism (C-LOT-R), and hope (HOPE scale). At follow-ups, participants completed the measure of psychological distress. Latent growth mixture modeling (LGMM) was used to identify trajectory patterns of distress. Multinominal logistic regression was then applied to identify predictors of trajectory patterns adjusted for demographic and medical characteristics.
Results: Of 229 participants, 120 (53%) had Stage 4 disease, while 99 (43%) had recurrent disease. Using LGMM, three distinct trajectories of anxiety and depression were identified: Low-stable (78%; 74%, respectively), High-declining (16%, 10%), and Chronic distress (6%; 16%). Most women showed low, stable levels of anxiety and depression. Anxiety trajectories were predicted by psychological unmet needs, optimism and symptom distress, whereas depression trajectories were predicted by optimism and symptom distress . Compared to women experiencing low stable anxiety trajectories, women experiencing the high-declining and chronic distress trajectories reported greater psychological unmet needs and pessimism; women in the high-declining group also had greater symptom distress. Similarly, compared to women experiencing a low stable depression trajectory, women on the high-declining and chronic distress trajectories reported pessimism and greater symptom distress.Conclusion: Most women with advanced breast cancer did not experience significant levels of psychological distress in the year following the diagnosis of ABC. Optimism, better psychological support and symptom management predicted resilience to distress.